Depression

Question 1

Correct or Not: depression is NOT normal consequence of aging

Answer 1

Correct

Question 2

What’s the mnemonics for depression sx?

Answer 2

• S leep changes: increase during day or decreased sleep at night
• I nterest (loss): of interest in activities that used to interest them
• G uilt (worthless): depressed elderly tend to devalue themselves
• E nergy (lack): common presenting symptom (fatigue)
• C ognition/C oncentration: reduced cognition &/or difficulty concentrating
• A ppetite (wt. loss); usually declined, occasionally increased
• P sychomotor: agitation (anxiety) or retardations (lethargic)
• S uicide/death preocp.

Question 3

Dysthymia - what is the timeline cutff>

Answer 3

> 2 years

Question 4

Post stroke depression, where is the lesion?

Answer 4

L hemisphere lesion of the prefrontal cortex up to 2 years after CVA

Question 5

How long the treatment should last?

Answer 5

• mono therapy preferred
• 6-12 month after remission
• most elderly will re maintenance therapy

Question 6

First line treatment?

Answer 6

SSRI

Question 7

Common side effects of SSRI

Answer 7

Parkinsonism, akathisia, anorexia, bradycardia, hypoNa, acute stroke risk, GI bleeding, fragility fracture

Question 8

Special SE with Citalopram (Celexa)?

Answer 8

Prolonged QT

Question 9

T or F? treating depression may impact medical mortality in cancer, stroke, and post-MI patients

Answer 9

T

Question 10

Depression + Neuropathic pain

Answer 10

SNRI

Question 11

2nd Line for depression

Answer 11

SNRI: venlafaxine (Effexor), duloxetine (cymbalta), mirtazapine (Remeron), buproprion (wellbutrin).

Question 12

3rd line for depression

Answer 12

Aripiprazole (Abilify), quetiapine (Seroquel), buproprion or buspirone

Question 13

Antidepressants to avoid in elderly

Answer 13

• Amitriptyline, doxepin, imipramine: for their anto-cholinergic effect, setting, and hypotensive effects
• TCAs: arrythmic, urine retention, orthostatic, may exacerbate dementia

Question 14

Pt with psychosis, catatonia, Depression + Parkinsonism

Answer 14

ECT

Question 15

Depression + Parkinson

Answer 15

Nortriptyline

Question 16

How to Dx Depression based on DSM5

Answer 16

• 5/9 sx, one must be depressed sx or loss of interest
• Sx during the same 2 weeks period
• a change from previous function

Question 17

Again, what are the precautions to take for starting patient on SSRI

Answer 17

• taking 4-6 wks after titling up to the dose
• may inc risk of hemorrhagic stroke
• check Na before start and after a few weeks of tx, prevent hyponatremia
• increase risk of GI and post-surgical bleeding

Question 18

First drug of the first line

Answer 18

Sertraline (Zoloft)

Question 19

What’s good and bad about prozac (fluoxetine)

Answer 19

• longer t1/2, better dosing schedule

- may exacerbate insomnia issue

Question 20

T or F: Wellbutrin is safe in HT patients, but lower sz threshold

Answer 20

T

Question 21

Duloxetine versus Effexor

Answer 21

D has more anticholinergic property, causing nausea, dry mouth

Question 22

What’s typical presentation of elderly who is depressed?

Answer 22

MORE LIKELY TO: 
Give somatic complaints
Feel worthlessness, rather than guilt	 
Demonstrate hypochondriasis	 
Have psychomotor retardation or agitation	 
Manifest psychotic delusions